Stroke Presentation PDF

Presentation by Lois Stevens Stroke Senior Lecturer  Overview Brief introduction to relevant cerebral circulation Stroke Link clinical presentation to site and severity of lesion  Cerebral Cortex Vast collection of cell bodies, axons and dendri...

Presentation by Lois Stevens Stroke Senior Lecturer  Overview Brief introduction to relevant cerebral circulation Stroke Link clinical presentation to site and severity of lesion  Cerebral Cortex Vast collection of cell bodies, axons and dendrites coving surface of cerebral hemispheres  Localized Function of Cerebral Cortex Primary sensory cortex – discriminates intensity and quality of sensory information Sensory association cortex – performs complex analysis of sensation Motor planning areas Primary motor cortex – descending control motor output Association cortex – controls behaviour, interprets sensation, processes emotions, memory Temporal and Occipital cortices? Homunculus  Stroke WHO – ‘ a rapidly developed clinical sign of focal disturbance of cerebral function of presumed vascular origin and of more than 24 hours duration’  Stroke Ischaemic Primary intracerebral haemorrage (ICH) Subarachnoid haemorrage (SAH) Please read about ICH and SAH as self- directed study Stroke Stroke  Stroke - Ischaemic 80% of all strokes due to occlusion (atheroma or emboli) Most common site is middle cerebral artery (then PCA and ACA in descending order of frequency) Brainstem strokes arise from disease in vertebral and basilar arteries https://youtu.be/BDk9wRbW40Q Middle Cerebral Artery Stroke Anterior Circulation  Stroke Involving MCA/ACA (anterior circulation stroke) MCA and ACA supply nearly all the outer brain surface, BG and internal capsule – infarct leads to diverse neurological sequelae Classic presentation: dense contralateral hemiplegia, contralateral hemianopia, cortical sensory loss speech and language difficulties: dysphasia (in left hemisphere lesions), dysarthria swallowing difficulty : dysphagia visuospatial disturbance (in right hemisphere lesions) unilateral neglect/inattention memory problems bladder control problems with executive function tonal changes (hypertonicity/ hypotonicity), altered reflexes Lesions Affecting Primary Sensory Cortex (PSC)/Sensory Association Areas PSC: involvement interferes with the localisation of tactile stimuli and proprioception. Quality and intensity of sensory stimuli may be altered. SAA: agnosia's - visual - auditory - stereognosis  Lesions Affecting Motor Planning Areas Damage to premotor or supplementary motor areas Apraxia - inability to perform a movement or sequence of movements despite intact sensation, automatic motor output and understanding of the task Motor perseveration – damage to supplementary motor area Broca’s aphasia  Lesions Affecting PMC Contralateral paresis Loss of fractionation of movement Dysarthria - spastic - flaccid  Lesions Affecting Association Cortex Prefrontal – loss of executive function - apathy and lack of goal directed behaviour. Can lead to inappropriate and risky behaviour – patients may show poor judgement and have difficulty conforming to social conventions. Parietotemporal – area specialised for communication and for understanding space, emotion and memory  Secondary Complications Gait Balance Postural alignment Muscle strength Decreased range of movement Falls Psychosocial  Patient Walking Following Stroke https://youtu.be/7HxintQBOdQ Questions please?